Provider Demographics
NPI:1578816401
Name:HOLMES, MICHAEL R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:HOLMES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY DRIVE C
Mailing Address - Street 2:ORTHOPEDICS
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15240
Mailing Address - Country:US
Mailing Address - Phone:412-360-1248
Mailing Address - Fax:412-360-6602
Practice Address - Street 1:1 UNIVERSITY DRIVE C
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15240-1000
Practice Address - Country:US
Practice Address - Phone:412-360-1124
Practice Address - Fax:412-360-6602
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004479363A00000X
PAMA057470363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant